Enhancing Chemotherapy Safety: Impact of Simulation on Staff Nurses' Knowledge and Clinical Skills – A Time Series Approach

Enhancing Chemotherapy Safety: Impact of Simulation on Staff Nurses' Knowledge and Clinical Skills – A Time Series Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Chemotherapy Safety: Impact of Simulation on Staff Nurses' Knowledge and Clinical Skills – A Time Series Approach Mr. Shashikumar Jawadagi, Binsha Pappachan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7430579/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Good knowledge and positive skilled clinical competency are the major weapons for nurses to handle chemotherapy agents, which can assist in raising the level of practice and thus have an impact on the nurses’ quality of life and better patient care. Materials and methods An experimental time series study was conducted with 30 samples selected by using cluster sampling to assess the effectiveness of simulation on knowledge and clinical competency regarding safe handling of chemotherapy drugs among staff nurses working in selected Hospitals at Mangaluru, India. Result The result showed that the majority 46.7% of samples were aged between 21 and 25 years and 30.0% were aged 26–30 years. The level of knowledge in pre-test, 56.7% samples had average, and 43.3% had moderate, in post-test-I, 93.3% had moderate, and 6.7% had good, whereas in post-test II, 50.0% had moderate, and 50.0% had good knowledge. The level of clinical competency in pre-test, 60% samples were at the competent level and 40% were at the advance beginner level, in post-test 83.3% were at the competent level, and 16.7% were at the expert level and post-test II, 73.3% were at expert level. The effect of simulation training showed significant differences in the knowledge and clinical competency mean scores of pre-test, post-test I, and post-test II. Thus, the p-value of 0.0001 showed that simulation was highly effective in enhancing the knowledge and clinical competency. Conclusion The simulation training enhances knowledge, professional growth, and clinical competence regarding safe handling of chemotherapy drugs among nurses. Clinical competency safe handling chemotherapy drugs staff nurses simulation Introduction Cancer is one of the second-largest killer diseases. The choice for treatment of cancer is chemotherapy, which is categorized as high risk especially for the nursing personnel, may be exposed to chemotherapeutic drugs during preparation, administration, drug transport, unpacking, storage, waste disposal, and cleaning drug spillage and can enter by ingestion or inhalation of airborne particles and through exposed mucous membranes and skin or by needle stick injuries. Nurses play a significant role during chemotherapy preparation and administration. 1 The nurses should possess high levels of knowledge and practice towards the safe management of chemotherapy. Therefore, the level of knowledge and practice techniques of safe handling of chemotherapeutic drugs becomes a major safety concern when handling chemotherapy drugs. So the good knowledge and skilled clinical competency are the major weapons for nurses in handling chemotherapy agents, which can assist in raising the level of safety and the quality of life of nurses. 2 , 3 Simulation is a teaching method and learning strategy used in the nursing and medical fields to help students understand theoretical knowledge and develop practical skills. Simulation emerged as an evidence-based teaching method that overcame challenges in traditional clinical settings, such as limited patient availability and safety concerns. This method uses scenarios to create an interactive learning environment that fosters teamwork, solidarity, and the ability to follow a specific protocol. It also encourages critical thinking and clinical reasoning through feedback between the educator and the team. 4 Hence, the purpose of the present study was to assess the simulation effect on the knowledge and clinical competency of staff nurses regarding the safe handling of chemotherapy drugs in selected hospitals in Mangaluru, India. The study aims to identify gaps in awareness, understanding, and practical skills among nurses, which are essential for minimizing occupational hazards and ensuring patient safety in oncology. Materials and methods A quantitative research approach with an experimental one-group pre and post-test research design was used to assess the effectiveness of simulation on clinical competency regarding safe handling of chemotherapeutic drugs among staff nurses working in selected Hospitals at Mangaluru, India, among nurses working in oncology units by using a cluster sampling technique selected 30 with an attrition rate of 10% samples (G power formula). The sampling criteria were the inclusion criteria: staff nurses who were working in the oncology ward, staff nurses who had a minimum of 1 year of clinical experience, and staff nurses who had completed GNM/ BSc/PPBSc/ MSc Nursing. The exclusion criteria were: the staff nurse had previously participated in the simulation/ any other educational programme on the same topic after joining as a staff nurse. Study Variables: Dependent variables were knowledge and clinical competency, independent variables were simulation on safe handling of chemotherapy drugs among staff nurses, and demographic variables were age, gender, type of position, educational status, year of experience, and having attended any CNE. Data collection tools: Data collection tools include demographic variables, a Structured knowledge questionnaire, and structured observation check list to assess clinical competency regarding safe handling of chemotherapy drugs. Data analysis technique: Descriptive statistics, frequencies, percentage, mean, median, standard deviation, and inferential t-test for finding the comparison between the pretest and post. Data collection procedure: Permission was obtained from the ethical committee and the hospital authority. Pre-assessment of knowledge and clinical competency. Simulation training was given to the participants. Soon after the simulation, the first post-test was conducted. The second post-test was after one month of simulation. Result Description of demographic variables: Table 1 shows that the majority of samples were aged between 21 and 25 years, that is, 46.7% and 30.0% were aged 26–30 years. 86.7% samples were female; 100.0% were staff nurses. In educational qualification, 70.0% were GNM and 30% were B.Sc Nursing. 30.0% had 1–2 years, 5–6 years, and 7 years and above, respectively. None of the samples attended the continuing Nursing Education (CNE) program. Assessment of the level of knowledge among study participants: Table No. 2 showed that the level of knowledge in pre-test 56.7% had average, and 43.7%had moderate knowledge, in post-test I 93.3% had moderate, and 6.7% had good knowledge, and in post-test 50.0% had moderate, and 50.0% had good knowledge, which is depicted in Table 2. Assessment of the level of clinical competency among study participants: Table No. 3 showed that, the level of clinical competency in pre-test 60% of samples were at the competent level and 40% were at the advance beginner level, in post-test 83.3% were at the competent level, and 16.7% were at the expert level and post-test II 73.3% were at the expert level, and 26.7% were at the competent level. No one was at the beginner level (Table 3). Effectiveness of simulation on knowledge regarding safe handling of chemotherapy drugs among staff nurses: Table No. 4 describes the effect of simulation training on knowledge related to the safe handling of chemotherapeutic drugs among staff nurses. There was a significant difference in the mean and standard deviation of the pre-test, which was 11.10 ± 2.48, the post-test I was 17.30 ± 2.17, and the post-test II was 20.10 ± 1.79. The p-value of 0.0001 showed that highly significant; it suggests that the simulation was highly effective in improving the knowledge. Effectiveness of simulation on clinical competency regarding safe handling of chemotherapy drugs among staff nurses: Table No. 5 describes the effect of simulation training on clinical competency related to the safe handling of chemotherapeutic drugs among staff nurses. There was a significant difference in clinical competency mean and standard deviation of pre-test was 11.50 ± 2.90, the post-test I was 25.53 ± 2.64, and post-test II was 29.40 ± 0.77. The p-value of 0.0001 showed that it was highly significant, suggesting that the simulation was highly effective in improving clinical competency. Correlation between knowledge and clinical competency regarding safe handling of chemotherapy drugs among staff nurses: Table no. 6 showed that there was no statistically significant correlation between knowledge and clinical competency before the intervention, as the p-value was more than 0.05 level of significance. These findings suggest that prior to the intervention, there was no meaningful correlation between the nurses’ knowledge and clinical competency, reinforcing the importance of targeted training to strengthen these interrelated aspects. Discussion Simulation is widely used to train healthcare students and professionals, serving as a valuable tool for teaching, learning, and evaluating clinical skills in nursing and midwifery education. Research indicates that this approach benefits both students and patients. It helps train professionals to perform safer and more timely interventions that meet international standards, which increases students' sense of responsibility toward clinical practice and improves the overall quality of care. 5 The majority of samples were aged between 21 and 25 years, that is 46.7%. A study conducted on nurses’ knowledge regarding preventing complications of central venous catheters (CVCs) in the intensive care unit showed that the majority of the study sample was female (76.7%), with 78.3% aged between 21 and 30 years. 6 In the present study, none of the participants had attended a Continuing Nursing Education (CNE) program. In the pre-test, 56.7% of the samples had an average knowledge level, and 43.3% had a moderate level. Following the first post-test, 93.3% of participants showed moderate knowledge, while 6.7% had good knowledge. By the second post-test, the group was evenly split, with 50% demonstrating moderate knowledge and 50% demonstrating good knowledge. A study reports that continuing Nursing Education (CNE) is a crucial process for nurses to enhance their professional knowledge, skills, and competence throughout their careers. It goes beyond the initial education and training required for licensure and is designed to keep nurse’s current with the latest developments in healthcare. 7 Initial clinical competency was evaluated in a pre-test, with 60% of the sample demonstrating a competent level and 40% at an advanced beginner level. Following the first post-test, there was a marked improvement, with 83.3% of the samples reaching the competent level and 16.7% achieving an expert level. The second post-test showed further growth, as 73.3% of the samples were at the expert level, and the remaining 26.7% were competent. A large body of evidence indicates a statistically significant improvement in knowledge and skill performance scores after nurses participate in simulation programs. This includes core skills such as patient assessment, medication administration, and the use of medical equipment. 8 A major benefit of simulation is its positive impact on nurses' confidence and their belief in their own ability to perform tasks effectively. Simulation scenarios often involve teams of healthcare professionals, which has been shown to improve teamwork, communication, and leadership skills. 9 This prepares nurses to collaborate effectively with doctors, other nurses, and various members of the healthcare team. The ability to practice and master complex skills in a controlled environment helps reduce procedural complications and medical errors, preparing nurses to be safer practitioners from the very beginning of their careers. 10 Conclusion The simulation training enhances knowledge, clinical competence and professional growth regarding safe handling of chemotherapy drugs among nurses. So regular training on safe handling of chemotherapy drugs is mandatory for safe and high-quality patient and self-care. Declarations Consent for publication: There is no obligations for publications by the ethical committee or authors · Availability of data and materials : Made available to research publics Author contribution : All authors contributed to the study conception and design and material preparation. All authors have Funding or Financial support and sponsorship: Funded by (Self) authors. Conflicts of interest: There is no conflict of interest by the authors. Human Ethics and Consent to Participate declarations : Applicable so Ethical committee permission was obtained (Yenepoya ethical committee-1). Ethical declaration: Yenepoya ethical committee-1 permission was obtained. ( Norma’s according to Indian Council of Medical Research( ICMR) . as Declaration of Helsinki to this effect in the ‘Ethics approval and consent to participate’ section. ICMR_National_Ethical_Guidelines.pdf Internal review board: Scientific review board of Yenepoya nursing college. Ethical approval Number: YEC-1/2023/360 dated 04-03-2024 (Yenepoya ethical committee-1). Consent to Participate declaration: written Participant consent was obtained Acknowledgments : The authors would like to thank authorities of the Hospitals of Mangalore and the participants of the study. References Mishra R, Bhawana, Kushwaha A. Chemotherapy Safe Handling through Educating Nurses: A Pre-Experimental Study. Int J Cancer Clin Res; 2021; 8:146. Sreekumaran Jisha, Goyal, Harindrjeet.et.al. Educational intervention program regarding safe administration of chemotherapy: A quasi-experimental study among nursing personnel in a tertiary care hospital. Journal of Education and Health Promotion2025 March;14(1):130. Alaraidh S, Alnaim LS, Almazrou SH. Impact of Educational Intervention on Compliance of Health Care Workers Towards Chemotherapy Handling Guidelines. J Multidiscip Healthc. 2023 Oct 16; 16:3035-3042. Koukourikos K, Tsaloglidou A, Kourkouta L, ea.al. Simulation in Clinical Nursing Education. Acta Inform Med. 2021 Mar;29(1):15-20. Simulation in nursing. WHO-EURO-2018-3296-43055-60253-eng.pdf (‎1.765Mb)‎ Jasim, Hadeel Basim; Hassan, eat.al Investigating nurses’ knowledge regarding preventing complications of central venous catheters (CVCs) in the intensive care unit: A descriptive study. Journal of Education and Health Promotion. 2025;14(1):54 Pushpa, Sharma A, Jangid J. Digging into the roots of continuing nursing education: potential uranium. Int J Community Med Public Health 2025; 12:2415-22. Saleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci. 2023 Jul-Aug;39(4):1185-1190. Colman N, Figueroa J, McCracken C, et al. Simulation-Based Team Training Improves Team Performance among Pediatric Intensive Care Unit Staff. J Pediatr Intensive Care. 2019 Jun;8(2):83-91. Rosen MA, DiazGranados D, Dietz AS, et.al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018 May-Jun;73(4):433-450. Erefai O, Elkhalloufi F, Azemmour Y, et.al. Assessing oncology nurses’ knowledge and practices in safe cytotoxic drug handling and waste management in a Moroccan tertiary centre. International Journal of Environmental Studies. 2025 Jan 2;82(1):612-22. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7430579","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542150132,"identity":"f99f8d48-f801-42fc-bac3-06a595edac68","order_by":0,"name":"Mr. Shashikumar 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Approach\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is one of the second-largest killer diseases. The choice for treatment of cancer is chemotherapy, which is categorized as high risk especially for the nursing personnel, may be exposed to chemotherapeutic drugs during preparation, administration, drug transport, unpacking, storage, waste disposal, and cleaning drug spillage and can enter by ingestion or inhalation of airborne particles and through exposed mucous membranes and skin or by needle stick injuries. Nurses play a significant role during chemotherapy preparation and administration.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe nurses should possess high levels of knowledge and practice towards the safe management of chemotherapy. Therefore, the level of knowledge and practice techniques of safe handling of chemotherapeutic drugs becomes a major safety concern when handling chemotherapy drugs. So the good knowledge and skilled clinical competency are the major weapons for nurses in handling chemotherapy agents, which can assist in raising the level of safety and the quality of life of nurses.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSimulation is a teaching method and learning strategy used in the nursing and medical fields to help students understand theoretical knowledge and develop practical skills. Simulation emerged as an evidence-based teaching method that overcame challenges in traditional clinical settings, such as limited patient availability and safety concerns. This method uses scenarios to create an interactive learning environment that fosters teamwork, solidarity, and the ability to follow a specific protocol. It also encourages critical thinking and clinical reasoning through feedback between the educator and the team.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHence, the purpose of the present study was to assess the simulation effect on the knowledge and clinical competency of staff nurses regarding the safe handling of chemotherapy drugs in selected hospitals in Mangaluru, India. The study aims to identify gaps in awareness, understanding, and practical skills among nurses, which are essential for minimizing occupational hazards and ensuring patient safety in oncology.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eA quantitative research approach with an experimental one-group pre and post-test research design was used to assess the effectiveness of simulation on clinical competency regarding safe handling of chemotherapeutic drugs among staff nurses working in selected Hospitals at Mangaluru, India, among nurses working in oncology units by using a cluster sampling technique selected 30 with an attrition rate of 10% samples (G power formula).\u003c/p\u003e\u003cp\u003eThe sampling criteria were the inclusion criteria: staff nurses who were working in the oncology ward, staff nurses who had a minimum of 1 year of clinical experience, and staff nurses who had completed GNM/ BSc/PPBSc/ MSc Nursing. The exclusion criteria were: the staff nurse had previously participated in the simulation/ any other educational programme on the same topic after joining as a staff nurse.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eStudy Variables: Dependent variables were knowledge and clinical competency, independent variables were simulation on safe handling of chemotherapy drugs among staff nurses, and demographic variables were age, gender, type of position, educational status, year of experience, and having attended any CNE.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eData collection tools: Data collection tools include demographic variables, a Structured knowledge questionnaire, and structured observation check list to assess clinical competency regarding safe handling of chemotherapy drugs.\u003c/p\u003e\u003cp\u003eData analysis technique: Descriptive statistics, frequencies, percentage, mean, median, standard deviation, and inferential t-test for finding the comparison between the pretest and post.\u003c/p\u003e\u003cp\u003eData collection procedure: Permission was obtained from the ethical committee and the hospital authority. Pre-assessment of knowledge and clinical competency. Simulation training was given to the participants. Soon after the simulation, the first post-test was conducted. The second post-test was after one month of simulation.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eDescription of demographic variables:\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;1 shows that the majority of samples were aged between 21 and 25 years, that is, 46.7% and 30.0% were aged 26–30 years. 86.7% samples were female; 100.0% were staff nurses. In educational qualification, 70.0% were GNM and 30% were B.Sc Nursing. 30.0% had 1–2 years, 5–6 years, and 7 years and above, respectively. None of the samples attended the continuing Nursing Education (CNE) program.\u003c/p\u003e\u003cp\u003eAssessment of the level of knowledge among study participants:\u003c/p\u003e\u003cp\u003eTable No. 2 showed that the level of knowledge in pre-test 56.7% had average, and 43.7%had moderate knowledge, in post-test I 93.3% had moderate, and 6.7% had good knowledge, and in post-test 50.0% had moderate, and 50.0% had good knowledge, which is depicted in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eAssessment of the level of clinical competency among study participants:\u003c/p\u003e\u003cp\u003eTable No. 3 showed that, the level of clinical competency in pre-test 60% of samples were at the competent level and 40% were at the advance beginner level, in post-test 83.3% were at the competent level, and 16.7% were at the expert level and post-test II 73.3% were at the expert level, and 26.7% were at the competent level. No one was at the beginner level (Table\u0026nbsp;3).\u003c/p\u003e\u003cp\u003eEffectiveness of simulation on knowledge regarding safe handling of chemotherapy drugs among staff nurses:\u003c/p\u003e\u003cp\u003eTable No. 4 describes the effect of simulation training on knowledge related to the safe handling of chemotherapeutic drugs among staff nurses. There was a significant difference in the mean and standard deviation of the pre-test, which was 11.10 ± 2.48, the post-test I was 17.30 ± 2.17, and the post-test II was 20.10 ± 1.79. The p-value of 0.0001 showed that highly significant; it suggests that the simulation was highly effective in improving the knowledge.\u003c/p\u003e\u003cp\u003eEffectiveness of simulation on clinical competency regarding safe handling of chemotherapy drugs among staff nurses:\u003c/p\u003e\u003cp\u003eTable No. 5 describes the effect of simulation training on clinical competency related to the safe handling of chemotherapeutic drugs among staff nurses. There was a significant difference in clinical competency mean and standard deviation of pre-test was 11.50 ± 2.90, the post-test I was 25.53 ± 2.64, and post-test II was 29.40 ± 0.77. The p-value of 0.0001 showed that it was highly significant, suggesting that the simulation was highly effective in improving clinical competency.\u003c/p\u003e\u003cp\u003eCorrelation between knowledge and clinical competency regarding safe handling of chemotherapy drugs among staff nurses:\u003c/p\u003e\u003cp\u003eTable no. 6 showed that there was no statistically significant correlation between knowledge and clinical competency before the intervention, as the p-value was more than 0.05 level of significance. These findings suggest that prior to the intervention, there was no meaningful correlation between the nurses’ knowledge and clinical competency, reinforcing the importance of targeted training to strengthen these interrelated aspects.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSimulation is widely used to train healthcare students and professionals, serving as a valuable tool for teaching, learning, and evaluating clinical skills in nursing and midwifery education. Research indicates that this approach benefits both students and patients. It helps train professionals to perform safer and more timely interventions that meet international standards, which increases students' sense of responsibility toward clinical practice and improves the overall quality of care.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe majority of samples were aged between 21 and 25 years, that is 46.7%. A study conducted on nurses’ knowledge regarding preventing complications of central venous catheters (CVCs) in the intensive care unit showed that the majority of the study sample was female (76.7%), with 78.3% aged between 21 and 30 years.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the present study, none of the participants had attended a Continuing Nursing Education (CNE) program. In the pre-test, 56.7% of the samples had an average knowledge level, and 43.3% had a moderate level. Following the first post-test, 93.3% of participants showed moderate knowledge, while 6.7% had good knowledge. By the second post-test, the group was evenly split, with 50% demonstrating moderate knowledge and 50% demonstrating good knowledge. A study reports that continuing Nursing Education (CNE) is a crucial process for nurses to enhance their professional knowledge, skills, and competence throughout their careers. It goes beyond the initial education and training required for licensure and is designed to keep nurse’s current with the latest developments in healthcare.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eInitial clinical competency was evaluated in a pre-test, with 60% of the sample demonstrating a competent level and 40% at an advanced beginner level. Following the first post-test, there was a marked improvement, with 83.3% of the samples reaching the competent level and 16.7% achieving an expert level. The second post-test showed further growth, as 73.3% of the samples were at the expert level, and the remaining 26.7% were competent. A large body of evidence indicates a statistically significant improvement in knowledge and skill performance scores after nurses participate in simulation programs. This includes core skills such as patient assessment, medication administration, and the use of medical equipment.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA major benefit of simulation is its positive impact on nurses' confidence and their belief in their own ability to perform tasks effectively. Simulation scenarios often involve teams of healthcare professionals, which has been shown to improve teamwork, communication, and leadership skills.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This prepares nurses to collaborate effectively with doctors, other nurses, and various members of the healthcare team. The ability to practice and master complex skills in a controlled environment helps reduce procedural complications and medical errors, preparing nurses to be safer practitioners from the very beginning of their careers.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe simulation training enhances knowledge, clinical competence and professional growth regarding safe handling of chemotherapy drugs among nurses. So regular training on safe handling of chemotherapy drugs is mandatory for safe and high-quality patient and self-care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eThere is no obligations for publications by the ethical committee or authors\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026middot; Availability of data and materials\u003c/strong\u003e: Made available to research publics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e: All authors contributed to the study conception and design and material preparation. All authors have\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding or Financial support and sponsorship:\u003c/strong\u003e\u0026nbsp; \u0026nbsp;Funded by (Self) authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e There is no conflict of interest by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e:\u0026nbsp;\u0026nbsp;Applicable so\u0026nbsp;Ethical committee permission was obtained (Yenepoya \u0026nbsp;ethical committee-1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical declaration:\u003c/strong\u003e Yenepoya \u0026nbsp;ethical committee-1 permission was obtained. (\u003cstrong\u003eNorma\u0026rsquo;s according to Indian Council of Medical Research( ICMR)\u003c/strong\u003e\u003cstrong\u003e. as\u003c/strong\u003e \u003cstrong\u003eDeclaration of Helsinki to this effect in the \u0026lsquo;Ethics approval and consent to participate\u0026rsquo; section.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eICMR_National_Ethical_Guidelines.pdf\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternal review board: Scientific review board of Yenepoya nursing college. \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval Number: YEC-1/2023/360 dated 04-03-2024\u0026nbsp;\u003c/strong\u003e(Yenepoya \u0026nbsp;ethical committee-1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration: written \u0026nbsp;Participant consent was obtained\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The authors would like to thank authorities of the Hospitals of Mangalore and the participants of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMishra R, Bhawana, Kushwaha A. Chemotherapy Safe Handling through Educating Nurses: A Pre-Experimental Study. Int J Cancer Clin Res; 2021; 8:146.\u003c/li\u003e\n\u003cli\u003eSreekumaran Jisha, Goyal, Harindrjeet.et.al. Educational intervention program regarding safe administration of chemotherapy: A quasi-experimental study among nursing personnel in a tertiary care hospital. Journal of Education and Health Promotion2025 March;14(1):130. \u003c/li\u003e\n\u003cli\u003eAlaraidh S, Alnaim LS, Almazrou SH. Impact of Educational Intervention on Compliance of Health Care Workers Towards Chemotherapy Handling Guidelines. J Multidiscip Healthc. 2023 Oct 16; 16:3035-3042. \u003c/li\u003e\n\u003cli\u003eKoukourikos K, Tsaloglidou A, Kourkouta L, ea.al. Simulation in Clinical Nursing Education. Acta Inform Med. 2021 Mar;29(1):15-20. \u003c/li\u003e\n\u003cli\u003eSimulation in nursing. WHO-EURO-2018-3296-43055-60253-eng.pdf (\u0026lrm;1.765Mb)\u0026lrm;\u003c/li\u003e\n\u003cli\u003eJasim, Hadeel Basim; Hassan, eat.al Investigating nurses\u0026rsquo; knowledge regarding preventing complications of central venous catheters (CVCs) in the intensive care unit: A descriptive study. Journal of Education and Health Promotion. 2025;14(1):54\u003c/li\u003e\n\u003cli\u003ePushpa, Sharma A, Jangid J. Digging into the roots of continuing nursing education: potential uranium. Int J Community Med Public Health 2025; 12:2415-22. \u003c/li\u003e\n\u003cli\u003eSaleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci. 2023 Jul-Aug;39(4):1185-1190.\u003c/li\u003e\n\u003cli\u003eColman N, Figueroa J, McCracken C, et al. Simulation-Based Team Training Improves Team Performance among Pediatric Intensive Care Unit Staff. J Pediatr Intensive Care. 2019 Jun;8(2):83-91.\u003c/li\u003e\n\u003cli\u003eRosen MA, DiazGranados D, Dietz AS, et.al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018 May-Jun;73(4):433-450.\u003c/li\u003e\n\u003cli\u003eErefai O, Elkhalloufi F, Azemmour Y, et.al. Assessing oncology nurses\u0026rsquo; knowledge and practices in safe cytotoxic drug handling and waste management in a Moroccan tertiary centre. International Journal of Environmental Studies. 2025 Jan 2;82(1):612-22.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clinical competency, safe handling, chemotherapy drugs, staff nurses, simulation","lastPublishedDoi":"10.21203/rs.3.rs-7430579/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7430579/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eGood knowledge and positive skilled clinical competency are the major weapons for nurses to handle chemotherapy agents, which can assist in raising the level of practice and thus have an impact on the nurses\u0026rsquo; quality of life and better patient care.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e\u003cp\u003eAn experimental time series study was conducted with 30 samples selected by using cluster sampling to assess the effectiveness of simulation on knowledge and clinical competency regarding safe handling of chemotherapy drugs among staff nurses working in selected Hospitals at Mangaluru, India.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eThe result showed that the majority 46.7% of samples were aged between 21 and 25 years and 30.0% were aged 26\u0026ndash;30 years. The level of knowledge in pre-test, 56.7% samples had average, and 43.3% had moderate, in post-test-I, 93.3% had moderate, and 6.7% had good, whereas in post-test II, 50.0% had moderate, and 50.0% had good knowledge. The level of clinical competency in pre-test, 60% samples were at the competent level and 40% were at the advance beginner level, in post-test 83.3% were at the competent level, and 16.7% were at the expert level and post-test II, 73.3% were at expert level. The effect of simulation training showed significant differences in the knowledge and clinical competency mean scores of pre-test, post-test I, and post-test II. Thus, the p-value of 0.0001 showed that simulation was highly effective in enhancing the knowledge and clinical competency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe simulation training enhances knowledge, professional growth, and clinical competence regarding safe handling of chemotherapy drugs among nurses.\u003c/p\u003e","manuscriptTitle":"Enhancing Chemotherapy Safety: Impact of Simulation on Staff Nurses' Knowledge and Clinical Skills – A Time Series Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 11:22:54","doi":"10.21203/rs.3.rs-7430579/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45c1e90d-e679-4c29-bd5e-6d6e738006fd","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T11:55:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 11:22:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7430579","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7430579","identity":"rs-7430579","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}